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South Africa’s Mental Health Crisis

In 2020, mental health accounted for 19% of Sanlam’s disability claims – up 11% from 2019. The increase is consistent with findings that COVID-19 has caused a global mental health crisis.

People are stressed, anxious and grieving. Lockdowns and loss have magnified depression. In a deeply unequal society like South Africa, the virus laid bare an existing mental healthcare service gap and the shocking public health crisis in the country.

While psychiatric services took an unavoidable step back during the successive lockdowns, they now have a crucial role to play.

The Impact of COVID-19

It has been a devastating time. People are, by nature and necessity, social. Many have experienced the inability to be at a loved one’s side during their final moments. There’s also limited capacity to grieve together – a Zoom funeral can never replace a real-life coming together.

There’s fatigue over the disease, pandemic protocols, and the incessant uncertainty. There’s survivor guilt – ‘Why did I survive and not my friend or family member?’

And then, there’s long COVID-19 and the inability to feel normal, months down the line, when everyone expects a full recovery. Many have reported depression, sleep disturbance, impaired concentration, and more.

Being ‘locked’ in our homes has had consequences too. There’s been an increase in gender-based violence. People have faced severe substance withdrawal.

There’s a feeling of displacement as some everyday rituals are lost and social connections are severed.

Statistics released by the South African Depression and Anxiety Group (SADAG) show the negative mental impact of quarantine. Young people are living in a bubble – quarantined in body and mind.

“At Sanlam, we’ve seen an increase in the use of mental health services by our team. We’re seeing more healthcare workers presenting with mental health issues – and PTSD in particular.

Already, 20% to 30% of the US’s healthcare workers are considering leaving the profession. And 4 in 10 nurses are contemplating leaving their roles as well.

South Africa is likely to see similar trends. Down the line, Sanlam is expecting to see the delayed impact of COVID-19 on mental health in the claims environment.

Collectively, we are going to be paying due to this pandemic for a long time.

Positively, it may shine some much-needed attention on our lack of mental health resources and facilities in this country. And the dire need for more people to have greater access to care,” said Dr Marion Morkel.

South Africa’s Mental Health Crisis Is Not New

Siphelele Nguse and Douglas Wassenaar’s Mental health and COVID-19 in South Africa shows that prior to the pandemic (2018), 1 in 6 South Africans already suffered from anxiety, depression or a substance use disorder, with 60% of people possibly dealing with post-traumatic stress.

However, just 27% of South Africans with severe mental disorders receive treatment. The same paper says that just 5% of the national health budget goes to mental health (for 2019) and only 50% of public hospitals with ‘mental health services’ actually have a psychiatrist.

Perhaps the pandemic has given us an opportunity to turn this around. Now’s the time to show collective will to broaden the reach of psychiatric services.

Dealing With the Aftermath

Naidu suggests that the pandemic may mean that more people present with post-traumatic stress; mood, anxiety and obsessive-compulsive disorders; and phobias.

A 2020 study by the Human Sciences Research Council found that 33% of South Africans were depressed, with 45% feeling fearful and 29% facing loneliness in the first lockdown.

People could access counselling, but many defaulted on appointments due to the risks perceived with in-person consultations. We are likely to see more consequences from these missed sessions.

Now’s the time for a focussed response from mental health workers. Nguse and Wassenaar say we need mental health to be front and centre of policy frameworks and national strategies.

It needs to be part of the national plan for recovery, with an emphasis on reaching our most vulnerable through consistent counselling and care.

We must explore all avenues of alternative interventions as well, including the opportunities brought about by telemedicine.

From an insurance perspective, we embarked on a mental health support programme for our clients last year. Through a series of webinars, the programme aimed to help them navigate the stresses of our COVID-19 world, from balancing family and work life, to managing grief during a pandemic.

We also expect to see an increase in mental health-related claims, not only as a primary diagnosis but as an existing comorbidity when individuals are diagnosed with a severe disease.

How to Protect Mental Health Right Now

Reabetsoe Buys, a psychologist based in Johannesburg, suggests that individuals take time for self-care and prioritise their holistic health.

Here are her five suggestions for looking after one’s mental health right now:

Stop what you’re doing, close your eyes and take a few deep breaths. Breathe in for four counts and out for four counts. This will slow your heart rate and calm you down.

Try and do a breathing or meditation exercise every morning and every evening for at least 15 minutes.
Identify what triggers you and problem-solve around it. Is it work, finances, relationships? What will help you manage it differently or deal with it better?

Walk it out. Moving your body will help to burn off some of the stress chemicals our bodies release when we’re anxious. It also allows you to focus on your body instead of only focussing on the anxiety-causing thoughts.

Put your thoughts on paper. By doing this, you externalise what is making you anxious, make it less daunting and clear your head, which makes it easier to problem-solve.

Watch what you’re consuming in terms of food and information. Diet-wise, it’s important to stay away from caffeine, nicotine and high sugar as these can trigger anxiety, but it is vital to consider your environment too.

You can do this by limiting your exposure to distressing news and social media. Of course, it is important to stay up to date but try to do so without taking on too much negative information.

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